Foreign nurse success story has message for Japan: Open up

Indonesian who passed test cites snail's pace of reform

The success story of Dewi Rachmawati may hold the key to coping with Japan’s declining population and quickly aging society. The struggles the Indonesian nurse has endured during her four years living in the country are what the government must rapidly remedy.

“It was a very challenging time,” Rachmawati, who arrived in Japan in August 2008 to become a certified nurse, told The Japan Times last month. In an essay she wrote in Japanese that won a special prize from the Japan Immigration Policy Institute, she said the country “is not prepared to open up as an international country.”

Tokyo, although having an economic partnership agreement with Indonesia and the Philippines to accept their nurse candidates, even appears “somewhat opposed to the idea,” she wrote. “Japan was a popular destination for nurses in Indonesia at first. But a number of those have given up and returned home, and it became clear for many that working in the country is not easy.”

Rachmawati, 27, arrived in Japan under the EPA with Indonesia that aims to secure medical and welfare staff as the society continues to age quickly.

The nurses must pass a national exam and become certified while training in the country. However, none of the 82 Indonesian applicants passed the test in 2009, while just two of 195 made it in 2010. In 2011, only 15 of the 285 Indonesians passed the exam.

The government was slow to realize that the tests, given in Japanese and laden with complex medical terminology, were simply too demanding for most applicants. It did ease the language burden by listing pronunciations next to difficult kanji, but that helped little. A mere 47 of the 415 combined Indonesian and Philippine nationals passed the exam in 2012 — an 11.3 percent rate of success.

Over 90 percent of Japanese, meanwhile, passed the test in 2012. Rachmawati was one of the 47 Indonesians and Filipinos who were certified. But despite working as a professional nurse at a Bali hospital for two years, it took her four years to take her first step as a nurse in Japan, she said. Her entire first year in the country was spent learning basic Japanese and the work routine, she said.

The second year was spent learning kanji and also getting accustomed to Japanese culture. Still, she failed the national exam two years in a row. In Japan, she said, she was an underachieving student.

Despite pondering a return home, Rachmawati said her luck changed when she met a Japanese doctor and a nurse “who were like (Florence) Nightingale” and inspired her to work harder. Her mentors helped her study for the national exam, which finally bore fruit last March.

Rachmawati is a rare breed who came to Japan and gritted her teeth until finally overcoming the challenges. Many others, including many friends, left empty-handed.

Japan, however, has a pressing need for more foreign nurses.

According to simulations released last January by the National Institute of Population and Social Security Research, Japan could see its population fall below 80 million by 2060 in the worst-case scenario.

As many as 43 percent of those in 2060 would be over the age of 65, the institute warned.

“We are beyond the point of discussing whether having immigrants or foreigners in the country should be tolerable or not,” former Tokyo Immigration Bureau chief Hidenori Sakanaka, who now heads the Japan Immigration Policy Institute, said during a Tokyo symposium in December.

Raising the birthrate, which is now below 1.4 children per woman, will be too slow as a cure for the graying nation, Sakanaka explained. He has even proposed allowing in 10 million immigrants in the next four decades.

The drastic population drop will devastate manufacturing, consumption, tax income, fiscal balance, pension, social security and other systems, Sakanaka warned. Securing foreign labor, especially nurses, will also be a race with other aging countries, including the U.K., where the shortage of nursing and medical personnel could reach as many as 250,000 by 2041, reports say.

For Rachmawati, Tokyo can do more to lure Indonesian nurses.

“Being flexible on work scheduling will help a lot,” she said, pointing out that it is impossible for Indonesian nurses to return home once they come to Japan, as they are required to work the same tight shifts as their Japanese colleagues. “Creating an appropriate education system for nurses who pass the national test as a followup is also important.”

As for Indonesian nationals thinking of the nursing program, she said strong determination is necessary. In addition to the demanding test, living in the country is not easy, even with the higher salaries, since prices here are higher than in Indonesia, Rachmawati added.

“One must have a strong heart and a tough spirit,” she said, adding one must also seek to improve. “I am very eager to study and continue learning in Japan about what it means to be a good nurse.”